Transplant Outcomes for Congenital Heart Disease Patients Bridged With a Ventricular Assist Device

Background: Ventricular assist device (VAD) use as a bridge to transplant (BTT) for children with end-stage heart failure and congenital heart disease (CHD), although challenging, has increased, but its effect on posttransplant outcome is unknown. This study describes posttransplant outcomes of CHD patients BTT with a VAD. Methods: All heart transplant recipients identified in United Network of Organ Sharing database from 2006 to 2015 (n = 21,865) were divided into four groups by those with (+) and without (–) a diagnosis of CHD and with (+) and without (–) VAD support at transplant: +CHD/+VAD, +CHD/–VAD, +VAD/–CHD, and –VAD/–CHD. Posttransplant survival of +CHD/+VAD was compared with +CHD/–VAD, –CHD/+VAD, and –CHD/–VAD in addition to pretransplant characteristics comparison between +CHD/+VAD and +CHD/–VAD. Results: Of 1,871 patients (8.6%) with CHD, 1,348 (72%) were younger than 18 years old, and 143 (7.6%) were BTT with a VAD (+CHD/+VAD). At transplant, +CHD/+VAD compared with +CHD/–VAD were more likely to have worse functional status (<50%: 60% vs 46%, p = 0.004), infections (29% vs 14%, p < 0.001), to be sensitized (47% vs 30%, p < 0.001) and on ventilator support (20% vs 13%, p = 0.029) and dialysis (13% vs 2.5%, p < 0.001). Overall, 1-year (84% vs 87%) and 5-year (72% vs 75%) survival was similar for +CHD/+VAD and +CHD/–VAD (p = 0.694). Survival was also similar when +CHD/+VAD were compared with –CHD/+VAD (n = 7,363; p = 0.529) and –CHD/–VAD (n = 12,613; p = 0.097). Conclusions: Although more ill pretransplant, CHD patients BTT with a VAD have similar posttransplant survival compared with CHD patients without a VAD and with other non–CHD heart transplant patients. VAD support may mitigate certain risk factors for poor posttransplant outcomes in the challenging CHD cohort.